More than 12 million people gained health care coverage through Medicaid and the Children's Health Insurance Program since the beginning of the coronavirus pandemic, with total enrollment reaching 83.6 million in July 2021, up from 71.2 million in February 2020.
Insurance enrollments through the health care marketplaces established by the Affordable Care Act have also risen to record levels, with 14.5 million people signing up for coverage this year.
As Larry Levitt of the Kaiser Family Foundation put it Wednesday, “We've never seen a safety net like this.”
But many of the gains in health coverage may prove to be temporary. Once the pandemic is officially over, states – which have been required to maintain coverage throughout the crisis – will once again start combing through their Medicaid rolls to remove those who are no longer eligible. As many as 15 million people could lose their coverage through that process, the Urban Institute says, including upwards of 6 million children.
Although the Biden administration recently extended the official state of emergency by three months, to April 15, state officials assume the Medicaid pullback will begin sometime in 2022. Some health officials say that the lack of a firm deadline will only make the process more difficult, and many are concerned that states will start removing people without properly informing them or giving them a chance to prove their eligibility, which typically hinges on employment, income levels and proper paperwork.
“That’s really one of the big risks, that people will be eligible but become unenrolled just because they don’t get the message and don’t know how to continue their coverage and are just out of the habit, quite honestly, of doing renewals and redeterminations after almost two years,” Suzanne Bierman, administrator of Nevada’s Medicaid program, told Politico.
Some states are expected to pursue Medicaid disenrollment aggressively. Ohio, for example, will use an outside vendor to automate the certification process over a 90-day period, with the vendor claiming a percentage of the money saved by removing ineligible people. Other states are also expected to move quickly, driven in part by the elimination of extra Medicaid matching funds provided by Congress during the pandemic, which will be eliminated at the end of the quarter in which the health emergency is declared to be over.
Democrats have proposed to continue the extra Medicaid funding in the Build Back Better package, but that bill has stalled in Congress and faces an uncertain future.